July 2021

Claim Submission Reminders for Providers and Billers

1. Neighborhood uses technology to scan paper forms and eliminate keystroke errors. All new and corrected claims must be submitted on original (not photocopied) print versions of the industry standard CMS-1500 and CMS-1450 (UB-04) forms, as they are printed in special optical character recognition (OCR)-scannable red ink.
2. Claim forms must not contain any handwritten elements, stamps, correction fluid, or staples.
3. Data entered on the claim form must be properly aligned and fall completely within the applicable text fields. Data that is misaligned or ghosted elsewhere on the form is systematically recognized as an error and will result in the claim being returned to the sender for correction.
4. It is not necessary to provide a W-9 form with a claim unless it is the first time a claim is submitted to Neighborhood on a provider’s behalf.

Electronic Claim Reconsiderations

Multiple requests for claim reconsiderations may be submitted in one e-mail, but each claim must include a completed Claim Reconsideration Request Form, the applicable remittance advice, medical notes, and must be saved in a separate file.  Multiple claims combined into a single file will be returned to the provider for correction.

In addition, duplicate and triplicate reconsideration requests will not be responded to as neighborhood will use the first submission as the official request in these instances.  For additional information, please review the claim reconsideration process in the Provider Manual.

Current Forms

Please remember to use the most current request forms available on our website.  Click here to access all necessary provider forms.  The Corrected (Replacement)/Voided Claim Request Form, Claim Reconsideration Request Form, and Provider Claim Dispute & Provider-Initiated Appeal Form are pdf “writeable,” so you can save the Form to your computer, type into the document, then email or print/fax for submission to Neighborhood.  Outdated forms will be returned to the sender for correction.

For help deciding which form to use, the Claim Form Finder, located in the Forms section of the Neighborhood website.

Provider Manual

Section 4 of Neighborhood’s Provider Manual contains updated information regarding claim billing and reimbursement.  For questions or concerns, Provider Services representatives are available Monday through Friday, 8:00am – 6:00pm EST by calling (800) 963-1001.